Dr. Szperka is a headache specialist and epidemiologist at the Children's Hospital of Philadelphia. Her prior work has focused on cohort studies examining headache characteristics and outcomes in patients with difficult-to-treat headaches. Her long-term goal is to develop novel approaches to studies of headache therapies to improve care for patients who are ineffectively treated. This grant will bridge prior observational work to that long-term goal, enabling her to conduct mentored research, and study clinical trial methodology and statistics to become an independently funded clinical trialist. Research: Migraine is a highly prevalent and disabling headache disorder in children, but 20- 30% of children with migraine are refractory to the available therapies. Trial design problems, including high placebo response rate and possible unbinding of subjects, have been major hurdles to proving efficacy. This proposal will (1) test efficacy of greater occipital nerve blocks with lidocaine in children/adolescents with acute migraine using a run-in trial design, (2) test whether lidocaine cream can blind subjects to lidocaine vs. saline injection, and (3) examine the relationship between perceived treatment, expectation of benefit, & pain reduction. These studies will lay the foundation for more efficient migraine trials. Environment and Career Development: Dr. Szperka is immersed in a rich tapestry of support which will promote her career development. The Children's Hospital of Philadelphia and the University of Pennsylvania are the homes for 3 of her mentors, Drs. Farrar, Dlugos, and Hsu, and the Center for Clinical Epidemiology and Biostatistics. In addition, Dr. Szperka's career will continue to be aided by colleagues in Headache Medicine, most notably her secondary advisor, Dr. Hershey, fellowship mentors from the Jefferson Headache Center, and the leadership of the American Headache Society. Dr. Szperka's mentoring team has extensive experience in NIH- funded clinical research, a history of training successful independent researchers, and a strong commitment to Dr. Szperka's career. The combination of expert mentorship, a deep clinical research infrastructure, and training in multi-site trials will mold Dr. Szperka into a clinical trialist who will advance trial design in migraine.